December 5, 2021

Depression after surgery: why you need to prepare

Depression can worsen after surgery, no matter how major or minor - preparation is key to your physical and mental health

Surgery causes many changes to the body and mind. In fact, surgery can cause significant anxiety and depression. Those emotions can then hurt your recovery, making it longer and more painful. Patients with pre-existing depression are at risk, but so are patients who don't have any pre-existing mood disorders.

Surgery can cause or worsen depression. Depression can hurt your recovery. Fortunately, there are many tools to prevent this.

Why is depression after surgery such a big problem?

Surgery is a major stressor to your body, both physically and psychologically. You're more likely to recover smoothly if your health is optimized. Depression disrupts many organs and can seriously set back your recovery. Here are some examples:

  • Orthopedic surgery: mood disorders can affect your outcomes after joint replacement, spine surgery, and carpal tunnel release. It doesn’t matter how large or small the operation is.
    • 13-32% of patients report emotional health issues at the time of knee replacement surgery. This is associated with worse knee replacement outcomes and more pain.
  • Heart surgery: depression is associated with longer recovery after surgery, worse quality of life, and more complications.
    • Depression affects many patients. In fast, about 1 in 5 patients have depression around the time of surgery.
  • Brain surgery: depression can complicate outcomes. Interestingly, a specific type of brain surgery to treat seizures (a condition called epilepsy) can actually improve depression and anxiety in some patients.
  • Depression can slow recovery, increase pain, and increase chance of infection.
    • Even the risk of serious complications, like blood clots, can increase with depression.
"It is well established that the emotional health of the patient influences the outcome of many common orthopedic surgeries"

- Ayers, et al. "The role of emotional health in functional outcomes after orthopaedic surgery: extending the biopsychosocial model to orthopaedics: AOA critical issues." The Journal of bone and joint surgery. American volume 95.21 (2013).

Depression around the time of surgery can have serious consequences. Surgery can make your depression worse, and worse depression can hurt your recovery. Fortunately, there are many tools to prevent and treat worsening depression after surgery.
Depression after surgery is real, and it's serious. Fortunately, There are many tools to prevent these complications after surgery.

Why treat depression before surgery?

Even if your surgeon does a perfect surgery, your outcome may not be ideal. In some cases, the reason may be from depression. Clearly, depression is associated with worse outcomes after surgery.

In addition, if you already have depression, your symptoms may get worse. Unfortunately, this can even happen with minor surgeries that don't require hospitalization.

The good news: depression can be treated before and after surgery. Even major surgery, like open heart surgery, can benefit from depression treatment. Treating depression doesn't always require medication. Tools like cognitive behavioral therapy can be incredibly effective, and can improve your mood for the rest of your life, even after surgery.

Meeting with your anesthesiologist before surgery can be incredibly helpful to help you take control over your outcome. In doing so, it can also reduce your anxiety before surgery. This can be a major tool in addressing depression around the time of surgery.


Tsapakis, Evangelia M., et al. "Modelling the effect of minor orthopaedic day surgery on patient mood at the early post-operative period: A prospective population-based cohort study." European psychiatry 24.2 (2009): 112-118.

Rosenberger, Patricia H., Peter Jokl, and Jeannette Ickovics. "Psychosocial factors and surgical outcomes: an evidence-based literature review." JAAOS-Journal of the American Academy of Orthopaedic Surgeons 14.7 (2006): 397-405.

Brander VA, Stulberg SD, Adams AD, Harden RN, Bruehl S, Stanos SP, Houle T.
Predicting total knee replacement pain: a prospective, observational study. Clin
Orthop Relat Res. 2003 Nov;(416):27-36.

Gandhi, Rajiv, et al. "Predicting the longer term outcomes of total knee arthroplasty." The Knee 17.1 (2010): 15-18.

Freedland, et al. Treatment of Depression After Coronary Artery Bypass Surgery: A Randomized Controlled Trial. Arch Gen Psychiatry. 2009;66(4):387–396. doi:10.1001/archgenpsychiatry.2009.7

Connerney et al. Relation between depression after coronary artery bypass surgery and 12-month outcome: a prospective study.  Lancet 2001;358 (9295) 1766- 1771

Khatri, Parinda, et al. "Perception of cognitive function in older adults following coronary artery bypass surgery." Health Psychology 18.3 (1999): 301.

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